Program Operations Manual System (POMS)

DI 23022.325 Small Intestine Cancer

COMPASSIONATE ALLOWANCE INFORMATION

SMALL INTESTINE CANCER

DESCRIPTION

Small Intestine Cancer forms in tissues of the small intestine. The most common type is Adenocarcinoma. Most of these tumors occur in the part of the small intestine near the stomach. They may grow and block the intestine.

The overall 5-year survival rate for resectable Adenocarcinoma is only 20%.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation: A pathology report and an operative report are the preferred methods for documentation. In the absence of these reports, the adjudicator may use a physician's opinion that indicates the cancer is inoperable or unresectable based on described objective findings. “Inoperable” refers to a physician's opinion that surgery would not be beneficial based on a review of imaging studies, laboratory results, and physical examination findings. Unresectable cancer is established when the operative report indicates that the cancer is not completely removed or the pathology report notes that the surgical specimen has positive margins.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.17

Small Intestine Cancer that is inoperable, unresectable, recurrent, or with distant metastases meets 13.17.

Medical Equals

* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.